The five different certified entitlement types each contain a subset of the fields and options listed alphabetically below.  Some fields are not available within all entitlement records, as they only apply to specific entitlement types, or are optional and must be turned on by Foothold Technology.

  NOTE: Once an insurance record has been entered for a client, an "Insurance Authorizations" entitlement type is available for entry.  For more information on working with Insurance Authorization information from within the Certified Entitlements feature, please click here.

Amount

In the Amount field, type or make changes to the amount of the entitlement (in dollars).

Benefits Assigned

Click this drop-down arrow and select "Yes" or "No" as appropriate.  This is used to record when the consumer has assigned benefits to the provider.

  TIP: This option is only applicable to non Medicare and Medicaid insurance entitlements. Because the system only wants you to enter benefits assignment information for records that are not of those two types, the option itself will only show up, if applicable, after you save the record and then re-open it in data entry mode. 

  NOTE: The selection here populates box 27 of the HCFA-1500 claim form for agencies that use the AWARDS BillingBuilder.

Coordination of Benefits

Click this drop-down arrow and select "Primary," "Secondary," or "Tertiary" as appropriate.  This is used to identify the payers when the client has more than one insurance plan.

Deductible Balance

This field can be used to identify the deductible balance for a consumer/eligibility.  Once entered, the balance decreases automatically when unpaid remainders are assigned to the Self-Pay payer in a remittance worksheet for those agencies using the AWARDS BillingBuilder.

  NOTE: This field is optional and must be turned on behind-the-scenes by Foothold Technology (on an agency-wide basis).  Please contact the Help Desk if it is not currently displayed on insurance records and you would like it to be.

Direct Deposit

Click the Direct Deposit drop-down arrow and select "Yes" or "No" to indicate whether any entitlements money is deposited directly into this account.

Effective

In the Effective field, type or make changes to the date on which the entitlement was approved, or on which the entitlement took affect (using mm/dd/yy format).  If this effective date is an estimated date and not confirmed, check the Estimated checkbox next to the date field.

  TIP: The effective date is a required field for certified entitlements.

Expires

In the Expires field, type or make changes to the date on which the entitlement must be re-approved (using mm/dd/yy format).  If this expiration date is an estimated date and not confirmed, check the Estimated checkbox next to the date field.

ID Number

In the ID Number field, type or make changes to the member ID number associated with the certified entitlement being entered or updated.

  TIP:  For Medicaid entitlements records, the ID number format can be changed to meet your state requirements.  Please contact the Help Desk to request a format change if needed.)  A value must be entered in the ID Number field for Medicaid records; however, if the Medicaid number is not known, you can enter "PENDING," "INELIGIBLE," or "SPEND DOWN" instead.

  NOTE: This ID is used in electronic billing files, and populates box 1a of the HCFA-1500 for agencies that use the AWARDS BillingBuilder.

Income Source / Eligibility / Accounts / Miscellaneous

  NOTE:  This information cannot be updated once a certified entitlement record has been saved.

Click the Standard drop-down arrow and select the income source, eligibility, account, or miscellaneous entitlement type.  If the appropriate entitlement type is not listed, select "Other" and enter the entitlement type in the Other Type field.

  TIP: Only one current record can be entered per entitlement type.

Is Consumer Subscriber

Click this drop-down arrow and select "Yes" or "No" to indicate whether the client is the subscriber of the coverage being entered.  This distinction allows AWARDS to send subscriber information other than the consumer's in the electronic 837 claim file and the paper HCFA-1500 claim form if the agency uses the AWARDS BillingBuilder.  This option can also be used to send a different responsible party on the consumer summary/statement other than the client.  The default selection is "Yes."

  NOTE: This field is optional and must be turned on behind-the-scenes by Foothold Technology (on an agency-wide basis).  Please contact the Help Desk if it is not currently displayed on insurance records and you would like it to be.

Payee

Click the Payee drop-down arrow and select "Self," "Agency," or "3rd Party Payee" to indicate who is the recipient of the entitlement money.  If "3rd Party Payee" is selected complete the 3rd Party Payee portion of the page with the payee's information, including name and contact information.

Private Insurance Group ID

In the Private Insurance Group ID field, type or make changes to the group ID number associated with the certified entitlement being entered or updated.

  NOTE: This ID is used for commercial insurance plans in 4010 billing for agencies that use the AWARDS BillingBuilder.  it is not to be used with the current 5010 billing.

Self-Pay / Co-Payment Amount

If applicable, in this field type the self-pay / co-payment amount associated with the client's plan.

Use Sliding Percent (%)

This field is only applicable when the Payer selected is "Self-Pay."  In those instances, enter the sliding scale percentage (as an integer between 1 and 100) to be used for the client.

  https://demodb.footholdtechnology.com/help/?10525